Postoperative complications in children with Crohn’s disease: an analysis of risk predictors

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Abstract

BACKGROUND: Crohn’s disease is an incurable progressive condition of the gastrointestinal tract in which up to 90% of patients undergo one or more surgical interventions during their lifetime. Despite the active development and implementation of new surgical techniques for the treatment of Crohn’s disease, the incidence of postoperative complications remains high, i.e., up to 25%–30%. Until now, the influence of various factors on the outcomes of surgical interventions and the choice of differentiated techniques for the surgical treatment of children with Crohn’s disease remain highly debatable.

AIMS: To study and identify possible risk factors for postoperative complications in children and adolescents with Crohn’s disease.

MATERIALS AND METHODS: A retrospective nonrandomized clinical study included 164 pediatric patients (boys, n = 106, 65%) with complicated forms of Crohn’s disease. Early results of surgical interventions on the intestines were analyzed (up to 30 days after surgery). Postoperative complications were noted in 15% of cases after the initial surgery (20/133). In half of the cases (66/133) re-interventions on the intestines were performed at different times after the initial surgery, of which postoperative complications were detected in 14% of the cases (9/66). To determine risk factors in dichotomous variables, contingency tables were constructed with the calculation of the odds ratio (OR) and their 95% confidence interval (95% CI). Differences were recognized as statistically significant at p < 0.05.

RESULTS: The following predictors of postoperative complications were identified: penetrating Crohn’s disease with strictures (OR 5,1; 95% CI 1,73–14,8; p = 0,0047), intestinal fistulas (OR 5; 95% CI 1,73–14,8; р = 0,0047), fibrosis in intestinal mucosal biopsy (OR 8,9; 95% CI 1,22–53; p = 0,0093), steroid therapy before surgery (OR 14,6; 95% CI 1,08–135; р = 0,0105), onset of CD in <6 years of age (OR 10,8; 95% CI 1,16–137; р = 0,0177), combination of CD of any localization with lesions of the upper gastrointestinal tract (OR 13,8; 95% CI 1,01–143; р = 0,0247), severe hypoalbuminemia (OR 9,62; 95% CI 1,04–122; p = 0,0228) and no specific therapy for Crohn’s disease after surgery (OR 10,8; 95% CI 1,16–137; p = 0,0177).

CONCLUSIONS: The development of surgical strategy in the preoperative period based on the identification of reliable predictors of adverse outcomes helps reduce the risk of postoperative complications. This improves the early outcomes of surgical treatment of children with complicated forms of Crohn’s disease.

About the authors

Olga V. Shcherbakova

Russian Children’s Clinical Hospital of Pirogov Russian National Research Medical University

Author for correspondence.
Email: Olga-03@yandex.ru
ORCID iD: 0000-0002-8514-3080
SPIN-code: 3478-8606

MD, Dr. Sci. (Med.), Head of the Surgical Department

Russian Federation, Moscow

Petr V. Shumilov

Pirogov Russian National Research Medical University

Email: peter_shumilov@mail.ru
ORCID iD: 0000-0002-9567-6761
SPIN-code: 6837-2789

MD, Dr. Sci. (Med.), Professor, Head of the V.A. Tabolin Department of Hospital Pediatrics

Russian Federation, Moscow

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